Surgical clamp



United States Patent SURGICAL CLAlVIP Luis R. Soltero, Houston, Tex.,and Stanly D. Greenberg,

Iowa City, Iowa Application October 15, 1956, Serial No. 616,080

4 Claims. (Cl. 128-322) This invention relates to surgical clamps forblood vessels and the like.

The foremost barriers tohead and neck surgery are the high mortality andthe neurological sequelae which followprolonged occlusion or ligation ofthe common and internal carotid arteries. Such prolonged occlusion orligation occurs when employing the previously known techniques andclamps wherein-total occlusion of the arteries is provided by clampspositioned transversely across 1 Patented July 8,1958

Fig. l is an elevation of the new and improved surgical clamp of thisinvention. t Fig. 2 is a plan view of the surgical clamp of this.

invention.

Fig. 3 is a view taken on line 3- -3 of Fig. 1 to illustrate inparticular the relationship between the gripping teeth on the jawsections and theinterfitting fixation means at the ends of the jawsections. I Fig. 4 is an end view taken on line 4-4 of Fig. 3, and itparticularly illustrates the construction of the interfitting fixationmeans which forms a part of the surgicalclamp of this invention.

Fig. 5 is a sectional view taken on line 5-5 of Fig. 3. In the drawings,the letter A designates generally the surgical clamp of this inventionwhich is adapted to be i used for the partial occlusion of the commonand internal carotid arteries or other blood vessels B, particularly 1those of medium and relatively small caliber. The sur-' gical clamp Aincludes a pair of jaw sections 10, each of which is substantiallyJ-shaped, as will be explained more fully hereinafter. The jaw sections10 are connected together at pivot means 12, which is preferably a boxor mortise joint, for movement toward and away from each other. Handlearms 14 areprovided for ef-" fecting the movement of the jaw sections10' toward and away from each other about the pivotal connection orjoint 12. Each of the arms 14 is a continuation of one of the jawsections 10. A ratchet type locking means 15 is provided between thearms 14 to lock the jaw sec-' tions 10 under increasing amounts ofpressure as the arms 14 are moved towards each other during the grip-Another object of this invention is to provide a new and improvedsurgical clamp for providing only partial occlusion of a blood vesselwhile isolating a portionof the vessel for the suturing of a rupturetherein without reducing the distal blood flow, and for other instanceswherein. it is desirable or necessary to isolate a portion of the vesselwithout reducing the distal blood flow.

Av particular object of this invention is to provide a new and improvedsurgical clamp having relatively thin jaw sections with teeth thereonfor gripping a relatively small blood vessel (the size of the internalor the external carotid arteries) longitudinally thereof, said jawsections also having interlocking fixation means to prevent scissoringor shifting of the jaw sections relative to each other while applyingclamping pressure to the jaw sections for bringing the walls of aportion of the blood vessel into contact with each other.

A further object of the invention is to provide a new and improvedsurgical clamp having substantially J- shaped jaw sections which areconnected together at a pivot joint and which are moved toward and awayfrom each other by handle sections extending upwardly therefrom, saidJ-shaped jaw sections having teeth thereon which are adapted to engage.the exterior of a blood vessel without puncturing same, and said clampalso having interfitting fixation means at the outer end ofeach jawsection and extending above the vessel and out of contact therewith whenthe jaw sections are in gripping engagement therewith to prevent the jawsections from scis'soring or shifting relative to each other.

The construction designed to carry out the invention will be hereinafterdescribed, together with other features thereof.

The invention will be more readily understood from a ping with the jawsections 10 on a blood vessel B or the" At the forward ends of the jawsections 10, an

like. interfitting fixation means 16 is provided for preventingscissoring or shifting of the jaw sections 10 as they are moved towardeach other during the clamping of the vessel B, whereby puncturing orother damage to the I vessel B is avoided. Thus, with suchfixation'means 16, as will be more fully explained hereinafter, the jawsections 10 are prevented from shifting during their movements towardand away from each other even though such jaw sections are maderelatively thin or narrow for use on the carotid arteries.

Considering the invention in more detail, each of the v jaw sections 10includes a plurality of teeth 20 which are adapted to interfit with theteeth 20 on the opposite jaw section 10 when the jaw sections 10 aremoved together. Each tooth 20 preferably has a depth or length of fromabout .015 of an inch to about .030 of an inch, although such depth orlength of each tooth may vary so long as the teeth do not rupture intothe intima or inner lining of the blood vessel with which the clamp is,used. Each tooth 20 is preferably formed with a ,point, wherein thetransversely extending walls are at an angle of about 25 to about 35",but preferably at about 30 as indicated in Fig. 3 of the drawings. Suchangle of the transversely extending side walls of each tooth 20 may bevaried, but preferably the foregoing range of, angles is provided. Thelongitudinally extending walls of each tooth 20 converge towards thepointed end of each tooth at an angle of from about 15 to about 25 withthe angle of about 25 being preferredas indicated in Fig. 5. Again, suchangle may be varied for various conditions. However, the foregoingangles and sizes with respect to the teeth 20 are important since theyassure the provision of teeth 20 which will indent or impress the outersurface of the vessel B without puncturing or rupturing same during thegripping of such vessel. V

Each jaw section 10 is provided with a first portion 1 10a, each ofwhich is adapted to extend substantially longitudinally or axially withrespect to the vessel B during the clamping thereof. A second or forwardportion b of each jaw section 10 extends upwardly and forwardly withrespect to the first portion 10c at an angle of from about 115 to about125, and preferably at an angle of about 120 as indicated in Fig. 1. Thesecond or forward portion 10b of each jaw section 10 is the shorter legof the J-shape, and the interfitting fixation means 16 is provided atthe upper ends of the forward portions 10b so that such fixation means16 is positioned above and out of contact with the vessel B when theclamp A is in use.

Each jaw section 10 also has a third or rearward portion 10c whichextends upwardly and rearwardly from each first portion 10a at an angleof from about 100 to 120, and preferably at an angle of about 110 asindicated in Fig. 1 of the drawings. It can be seen from Fig. 1 thateach rearward or third portion 10c forms the longer leg of the J-shapeof each jaw section 10, and in the ordinary case, the rearward portions100 are approximately 1 /2. inches to about 2 inches in length tofacilitate the positioning of the clamp A lengthwise of the vessel B.The jaw portions 10a may vary in length from about A inch to about 1inch, depending upon the portion of the blood vessel requiring clamping.

The handle arms 14 extend rearwardly and upwardly from the thirdportions 100 of the jaw sections 10 at an angle of from about 120 toabout 140 with respect to such third portions 10c, and preferably at anangle of about 130 as indicated in Fig. l of the drawings. Such upwardinclination of the arms 14 facilitates the use of the clamp on bloodvessels disposed relatively large distances below the skin, and morespecifically, the common and internal carotid arteries in the neck. Suchupward inclination of the arms 14 further facilitates the location ofthe jaw sections 10 lengthwise of the vessel B during the clampingoperation. Each of the handle arms 15 has a handle ring 19 formedtherewith for receiving a finger and the thumb of the surgeon using theclamp A. Such handle rings 19 preferably lie in the same plane as thehandle arms 14. The pivotal connection 12 also lies in the same plane asthe handle arms 14 and is of a conventional construction, preferably ofthe box or mortise joint type with a rivet or pivot pin 22 extendingthrough the joint 12. In some instances, the pivotal connection 12 maybe located between the third or rearward portions 10c of the jawsections 10 so as to lie in the plane therewith rather than in the planewith the handle arms 14 as shown in the drawings. Such will ordinarilybe the construction when the clamp A is reduced in size for use onsmaller blood vessels.

The ratchet locking means 15 is of a conventional construction andincludes a ratchet tooth member 23 which may have one or more ratchetteeth and which is adapted to cooperate with a plurality of ratchetteeth 25. As the handle arms 14 are moved towards each other, theratchet tooth member 23 slides over the ratchet teeth 25 so as tosuccessively lock the handle arms 14 closer together until the maximumpressure is applied to the jaw sections 10. Such ratchet lock means 15is released in a known manner by shifting the handle rings 19 and thusthe arms 14 vertically with respect to each other so that the ratchettooth 23 can be moved away from the ratchet teeth 2 to separate the arms14.

The interfitting fixation means 16 at the forward ends of the jawsections 10 includes an inwardly extending projection or tooth 30 whichis affixed or formed integrally with one of the jaw sections 10 forinterfitting within a recess 31 formed in the other of the jaw sections10. The width of the projection 30 is substantially the same throughoutits length, and the width of the recess 31 is also substantially thesame throughout its length and is only slightly larger in width than theprojection 30. Thus, as the projection 30 moves into the recess 31, verylittle shifting movement, if any, of the jaw sections relative to eachother is possible because of the relatively narrow clearance between theexternal surface of the tooth 30 and the wall or inner surface of therecess 31. This condition exists from the time that the tooth 30 entersthe recess 31 until it is fully telescoped or seated in such recess 31.

The tooth 30 actually enters the recess 31 prior to the time the tooth23 locks with the first of the teeth 25 on the ratchet locking means 15.Therefore, prior to the time that any appreciable gripping force isapplied to the jaw sections 10 on the vessel B with which the clamp A isused, the projection 30 is in the recess 31 and therefore scissoring orshifting of the jaw sections 10 with respect to each other as they aremoved towards each other is avoided or prevented. Since the constructionof the interfitting fixation means 16 prevents substantially allshifting of the jaw sections 10 relative to each other, the teeth 20 maybe relatively sharp or pointed for indenting or impressing the outersurface of the vessel B without creating the danger of rupturing orpuncturing the wall of the vessel B. Such situation is extremelyimportant in surgical clamps, and particularly in a clamp which ispositioned lengthwise of the blood vessel B and which has relativelythin jaw sections which are more subject to flexing and shifting as theyare moved towards each other.

In the use of the clamp A of this invention, it is positioned asillustrated in Fig. 1 with the first or lower portions 10a of the jawsections 10 substantially longitudinal or axial with respect to thevessel B and at aposition on the vessel B so as to obtain between about30% to about 55% occlusion of the blood flowing through the vessel. Ofcourse, the amount of occlusion can be varied, but it is necessary froma surgical standpoint to limit the amount of the occlusion to no morethan about 55 particularly when dealing with arteries flowing blood tothe brain. Each jaw portion 10a is built no thicker than about 3 inch toeffect minimum occlusion of blood flow through the blood vessel withmaximum exposure of the portion of the blood vessel to be operated upon;The interfitting fixation means 16 extends above the upper surface ofthe vessel B so that the projection 30 does not puncture or contact thevessel B at any time. The fixation means 16 prevents the shifting of thejaw sections 10 as the jaw sections 10 are moved toward each other bythe movement of the handle arms 14. As previously mentioned, thefixation means 16 is effective prior to the time that the ratchetlocking means 15 begins to function so that there is no opportunity fora shifting. of the jaw sections 10 as the gripping pressure is appliedwith the jaw sections 10 to the vessel B. The portion of the vessel Bidentified by the letter X (Fig. 1) above the jaw sections 10 iscompletely cut off from the flow of blood and is isolated from the restof the vessel B so that an incision'may be made for the subsequentinsertion of a tube to elfect the by-pass of blood therethrough. Thus,with the clamp A of this invention, such incision can be made withoutcausing any loss of blood and by reason of the fixation means 16, noscissoring or shifting of the jaw sections 10 occurs as the vessel B isclamped to isolate such section X.

It should be pointed out that the size of the clamp A may be varied foruse in connection with different sizes of vessels or arteries, butordinarily, the rear or third portions of the jaw sections 10 remainssubstantially the same length, namely, about one and one half inches toabout two inches so as to permit the positioning of the jaw sections 10on the vessel B. Also, as previously mentioned, the pivotal connection12 may be located between the rearward portions 100 of the jaw sections10 and in thesame plane therewith instead of in the plane with thehandlearms 14 as illustrated in the drawings. In this connection, it should bepointed out that although there are teeth 20 on the rearward portion100, they do not ordinarily extend upwardly beyond the height of theforward or second portions b of the jaw sections 10.

The foregoing disclosure and description of the invention isillustrative and explanatory thereof and various changes in the size,shape and materials, as well as in the details of the illustratedconstruction, may be made within the scope of the appended claimswithout departing from the spirit of the invention.

What is claimed is:

1. A surgical clamp for partial occlusion of blood vessels and the like,comprising a pair of opposed jaw sections adapted to be positionedlengthwise of a blood vessel and having teeth thereon which interengagewhen the jaw sections are brought together, said teeth being of a lengthto indent the vessel without rupturing same, pivot means pivotallyconnecting said jaw sections together for movement towards and away fromeach other, a handle arm joined with each jaw section for forming anextension thereof beyond said pivot means to eflect the movements ofsaid jaw sections towards and away from each other, said jaw sectionseach having a first portion adapted to extend longitudinally of thevessel, a second portion extending upwardly and forwardly at an angle offrom about 115 to about 125 from said first portion, and a third portionextending upwardly and rearwardly at an angle of about 100 to about 120from said first portion, said handle arms extending rearwardly at anangle of from about 120 to about 140 from said third portion, andinterfitting fixation means at the upper ends of said second portions ofsaid 6 jaw sections extending above the vessel being gripped by said jawsections for preventing shifting of the jaw sections as they are movedtowards each other in applying clamping pressure to the vessel duringthe partial occlusion of same.

2. The structure set forth in claim 1, wherein said fixation meansincludes an elongate recess on one of said jaw sections which issubstantially the same width throughout its depth, and an elongateprojection on the other jaw section adapted to extend into said recessand which is slightly narrower in width throughout its length than saidrecess whereby the alignment of said projection in said recess isassured and maintained from the time the projection is initiallyinserted into said recess until the projection contacts the bottom ofsaid recess.

3. The structure set forth in claim 1, wherein the teeth on each jawsection are from approximately 0.015 of an inch to approximately 0.030of an inch in height to prevent puncture of the intima of the vesselwhen gripping same.

4. The structure set forth in claim 1, wherein said interlittingfixation means includes a notched element on one of said jaw sectionsand a projection on the other jaw section, both of which extend inwardlytowards each other to interfit prior to the application of a squeezingforce to said vessel with said jaw sections.

References Cited in the file of this patent Stille Haemostats: pamphletissued on October of 1949, by Scanlan Morris, page 5 type 23-53.

